William was doing great.  His C. Diff  was finally gone after a month taper of vancomycin.  He was stronger.  The nursing home staff reveled in how much progress was being made over such little time.  It seemed every one was ecstatic, except for, of course his family.  Every step this octogenarian took forward was accompanied by a litany of concerns and complaints from his daughter. If he was not gaining weight, ...

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I see it again and again in my practice: parents who seem to have forgotten that they are in charge. "You can say no," I find myself saying to family after family. Which is kind of an amazing thing to have to say, if you think about it. You'd think that parents would know that they can say no when their child asks for yet another toy, to watch more television, ...

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For three years before I applied to medical school, I worked in post-Katrina New Orleans helping to rebuild school-based health centers. One of the main challenges, however, was how to create a sustainable safety net for at-risk youth to whom we were hoping to provide much needed health services -- key word being “sustainable.” All too often, there isn't funding to carry out primary care’s mission of improving the health of communities and ...

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Today’s article highlights the lingering problem of physicians buying and selling prescription medications to patients -- at a profit. The medical profession has struggled with this controversial practice  for more than 150 years. In George Eliot’s 1874 novel “Middlemarch,” an idealistic young doctor named Tertius Lydgate questions the ethics of fellow physicians who make handsome profits prescribing and dispensing their own remedies to the townsfolk. His medical colleagues shun him for it. Around ...

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When I was in medical residency, more than thirty years ago, I ran with a pack of fellow residents, all guys who were fit to varying degrees. Once, on an outing, we discussed the -- hopefully -- hypothetical question: "If the need arose, which one of us would we eat first?" "Randy!" my friends gleefully concluded. "His meat would be the most marbled," one added. I've never been fat. More accurately, my body ...

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Internal medicine requires knowledge, deduction, and many skills: history taking, physical examination, analyzing diagnosis tests. When confronting a new patient problem, we use our brains to work on finding a diagnosis. Much like police detectives, we would like to have brilliant diagnostic epiphanies, but often we make our diagnoses by painstakingly collecting all the clues and doing the necessary boots on the ground work. We had a woman admitted to our ...

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Marcus Welby wont survive todayMarcus Welby wont survive today An excerpt from So Long, Marcus Welby, M.D.: How Today's Health Care Is Suffocating Independent Physicians - and How Some Changed to Thrive. A 30-ish public-relations executive representing a large, modern physician practice was shaking her head in puzzlement. Her physician client liked to talk about how his practice was not "a ...

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The blonde minority: Sexism is alive in medicine While demographic data may suggest otherwise, I still consider myself a minority, albeit a less common one. I am a young woman in medicine, and I am a natural blonde. I barely qualify for a prescription for eyeglasses, but I have found they give credence to my words and patients seem to take me more seriously. Perhaps three years of residency training ...

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Part of a series. In earlier posts, I have described direct primary care (DPC) in its various forms called membership, retainer and concierge. There are some concerns with DPC. Does more doctor-patient time really mean better quality care? Does it really mean lower total costs? It seems logical that closer care means better care, fewer referrals to specialists and fewer hospitalizations. Most DPC physicians will tell you this is the case ...

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I don't like to brag, but if there is one area of my skills as a doctor about which I am proud, it would be my skill as a diagnostician.  I like to play Sherlock Holmes and figure out what's going on with people, and I think I'm pretty good at it. So I lied.  I do like to brag ... a little. In most people's mind's eye, the role of diagnostician ...

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